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Hui D, Bruera E. The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments. J Pain Symptom Manage 2017; 53:630-643. [PMID: 28042071 PMCID: PMC5337174 DOI: 10.1016/j.jpainsymman.2016.10.370] [Citation(s) in RCA: 432] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/04/2016] [Accepted: 10/12/2016] [Indexed: 12/16/2022]
Abstract
CONTEXT Routine symptom assessment represents the cornerstone of symptom management. Edmonton Symptom Assessment System (ESAS) is one of the first quantitative symptom assessment batteries that allows for simple and rapid documentation of multiple patient-reported symptoms at the same time. OBJECTIVES To discuss the historical development of ESAS, its current uses in different settings, and future developments. METHODS Narrative review. RESULTS Since its development in 1991, ESAS has been psychometrically validated and translated into over 20 languages. We will discuss the variations, advantages, and limitations with ESAS. From the clinical perspective, ESAS is now commonly used for symptom screening and longitudinal monitoring in patients seen by palliative care, oncology, nephrology, and other disciplines in both inpatient and outpatient settings. From the research perspective, ESAS has offered important insights into the nature of symptom trajectory, symptom clusters, and symptom modulators. Furthermore, multiple clinical studies have incorporated ESAS as a study outcome and documented the impact of various interventions on symptom burden. On the horizon, multiple groups are actively investigating further refinements to ESAS, such as incorporating it in electronic health records, using ESAS as a trigger for palliative care referral, and coupling ESAS with personalized symptom goals to optimize symptom response assessment. CONCLUSION ESAS has evolved over the past 25 years to become an important symptom assessment instrument in both clinical practice and research. Future efforts are needed to standardize this tool and explore its full potential to support symptom management.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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152
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Shalom-Sharabi I, Samuels N, Lavie O, Lev E, Keinan-Boker L, Schiff E, Ben-Arye E. Effect of a patient-tailored integrative medicine program on gastro-intestinal concerns and quality of life in patients with breast and gynecologic cancer. J Cancer Res Clin Oncol 2017; 143:1243-1254. [DOI: 10.1007/s00432-017-2368-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/09/2017] [Indexed: 11/12/2022]
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153
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Masel EK, Huber P, Engler T, Watzke HH. Heart rate variability during treatment of breakthrough pain in patients with advanced cancer: a pilot study. J Pain Res 2016; 9:1215-1220. [PMID: 28003771 PMCID: PMC5161332 DOI: 10.2147/jpr.s120343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Decisions on the intensity of analgesic therapy and judgments regarding its efficacy are difficult at the end of life, when many patients are not fully conscious and pain is a very common symptom. In healthy individuals and in postoperative settings, nociception and subsequent pain relief have been shown to induce changes in the autonomic nervous system (ANS), which can be detected by measuring heart rate variability (HRV). Objectives The changes in the ANS were studied by measuring HRV during opioid therapy for cancer breakthrough pain (CBTP) in palliative-care patients with cancer and compared these changes with patient-reported pain levels on a numeric rating scale (NRS). Patients and methods The study included ten patients with advanced cancer and baseline opioid therapy. In each patient, a 24-hour peak-to-peak HRV measurement with a sampling rate of 4,000 Hz was performed. High frequency (HF), low frequency (LF), total power, pNN50 (indicating parasympathetic activity), and log LF/HF were obtained in two intervals prior to therapy and in four intervals thereafter. Intensity of CBTP was recorded using a patient-reported NRS prior to therapy and 30 minutes afterward. Results CBTP occurred in seven patients (three males and four females; mean age: 62 ± 5.2 years) and was treated with opioids. A highly significant positive correlation was found between opioid-induced reduction in patient-reported pain intensity based on NRS and changes in log LF/HF (r > 0.700; p < 0.05). Log LF/HF decreased in patients who had a reduction in pain of >2 points on the NRS but remained unchanged in the other patients. Conclusion Our data suggest that log LF/HF may be a useful surrogate marker for alleviation of CBTP in patients with advanced cancer and might allow detection of pain without active contribution from patients.
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Affiliation(s)
- Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Patrick Huber
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Tobias Engler
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Hans Watzke
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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154
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Girgis A, Delaney GP, Arnold A, Miller AA, Levesque JV, Kaadan N, Carolan MG, Cook N, Masters K, Tran TT, Sandell T, Durcinoska I, Gerges M, Avery S, Ng W, Della-Fiorentina S, Dhillon HM, Maher A. Development and Feasibility Testing of PROMPT-Care, an eHealth System for Collection and Use of Patient-Reported Outcome Measures for Personalized Treatment and Care: A Study Protocol. JMIR Res Protoc 2016; 5:e227. [PMID: 27884813 PMCID: PMC5146324 DOI: 10.2196/resprot.6459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/16/2016] [Accepted: 10/28/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures have been used widely to screen for depression, anxiety, and symptoms in cancer patients. Computer-based applications that collect patients' responses and transfer them to the treating health professional in real time have the potential to improve patient well-being and cancer outcomes. OBJECTIVE This study will test the feasibility and acceptability of a newly developed eHealth system which facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. METHODS The eHealth system is being developed in consultation with 3 overarching content-specific expert advisory groups convened for this project: the clinical advisory group, technical advisory group, and evaluation advisory group. The following work has already been completed during this phase of the study: the Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) eHealth system was developed, patient-reported outcomes were selected (distress, symptoms, unmet needs), algorithms to inform intervention thresholds for clinical and self-management were determined, clinician PRO feedback summary and longitudinal reports were designed, and patient self-management resources were collated. PROsaiq, a custom information technology system, will transfer PRO data in real time into the hospital-based oncology information system to support clinical decision making. The PROMPT-Care system feasibility and acceptability will be assessed through patients completing PROMPT-Care assessments, participating in face-to-face cognitive interviews, and completing evaluation surveys and telephone interviews and oncology staff participating in telephone interviews. RESULTS Over the course of 3 months, the system will be pilot-tested with up to 50 patients receiving treatment or follow-up care and 6 oncology staff at 2 hospitals in New South Wales, Australia. Data will be collected to determine the accuracy and completeness of data transfer procedures, extent of missing data from participants' assessments, acceptability of the eHealth system and usefulness of the self-management resources (via patient evaluation surveys and interviews), and acceptability and perceived usefulness of real-time PRO reporting (via oncology staff interviews) at the completion of the pilot phase. CONCLUSIONS This research investigates implementation of evidence into real world clinical practice through development of an efficient and user-friendly eHealth system. This study of feasibility and acceptability of the newly developed eHealth system will inform the next stage of larger scale testing and future implementation of the system as part of routine care. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0).
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Affiliation(s)
- Afaf Girgis
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Anthony Arnold
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Alexis Andrew Miller
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Centre for Oncology Informatics, University of Wollongong, Wollongong, Australia
| | - Janelle V Levesque
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Department of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Nasreen Kaadan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Martin G Carolan
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Nicole Cook
- Cancer Institute New South Wales, Sydney, Australia
| | - Kenneth Masters
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Thomas T Tran
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Tiffany Sandell
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Ivana Durcinoska
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Martha Gerges
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Sandra Avery
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Weng Ng
- Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, Liverpool, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | | | - Haryana M Dhillon
- Faculty of Science, Central Clinical School, The University of Sydney, Sydney, Australia
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155
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Boonstra AM, Stewart RE, Köke AJA, Oosterwijk RFA, Swaan JL, Schreurs KMG, Schiphorst Preuper HR. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing. Front Psychol 2016; 7:1466. [PMID: 27746750 PMCID: PMC5043012 DOI: 10.3389/fpsyg.2016.01466] [Citation(s) in RCA: 294] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/12/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure. Results and conclusion: The study showed that NRS scores ≤ 5 correspond to mild, scores of 6-7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4-6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low catastrophizing than for those with high catastrophizing. However, we found the opposite. The fact that we did not find the same optimal CP scheme in the subgroups with lower and higher catastrophizing tendency may be due to chance variability.
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Affiliation(s)
- Anne M Boonstra
- 'Revalidatie Friesland' Centre for Rehabilitation Beetsterzwaag, Netherlands
| | - Roy E Stewart
- Department of Health Sciences, Community and Occupational Medicine, University Medical Centre Groningen, University of Groningen Groningen, Netherlands
| | - Albère J A Köke
- Adelante Centre of Expertise in Rehabilitation and AudiologyHoensbroek, Netherlands; Department of Rehabilitation Medicine, CAPHRI Research School, Maastricht UniversityMaastricht, Netherlands; Faculty of Health and Technology, Zuyd University for Applied SciencesHeerlen, Netherlands
| | - René F A Oosterwijk
- Department of Rehabilitation Medicine, MGG Medical Centre Alkmaar and Gemini Hospital Den Helder Alkmaar, Netherlands
| | | | | | - Henrica R Schiphorst Preuper
- Department of Rehabilitation, Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen Groningen, Netherlands
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156
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Ben-Arye E, Rosenberg SK, Samuels N. Integrative physicians and an herbal cancer "cure". Transl Lung Cancer Res 2016; 5:443-5. [PMID: 27652207 DOI: 10.21037/tlcr.2016.07.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Oncologists are frequently asked about herbal remedies claiming to "cure" cancer, or at least delay its progression. While complementary and integrative medicine (CIM) should be aimed primarily at improving quality-of-life (QOL) related concerns, "wonder cures" are part of an alternative health belief model providing hope for a "miracle" where conventional treatment has failed. We describe a physician with extensive small-cell lung cancer (SCLC) undergoing chemotherapy, with significant toxicities and impaired daily function. He had come for an integrative physician (IP) consultation, provided by a medical doctor dually trained in CIM and supportive cancer care, taking place in a conventional supportive cancer care service. We describe the IP consultation in general and regarding an herbal remedy which was being promoted as a "cure" for cancer. The subsequent patient-tailored CIM treatment process, in which patients receive evidence-based guidance on treatments which address QOL-related concerns, are presented.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Clalit Health Services, Haifa, Israel;; Lin Medical Center, Department of Family Medicine, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;; Complementary and Traditional Medicine Unit, Department of Family Medicine, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shoshana Keren Rosenberg
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Clalit Health Services, Haifa, Israel;; Lin Medical Center, Department of Family Medicine, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, Haifa and Western Galilee Oncology Service, Clalit Health Services, Haifa, Israel;; Lin Medical Center, Department of Family Medicine, Affiliated with the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel;; Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
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157
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Bao T, Basal C, Seluzicki C, Li SQ, Seidman AD, Mao JJ. Long-term chemotherapy-induced peripheral neuropathy among breast cancer survivors: prevalence, risk factors, and fall risk. Breast Cancer Res Treat 2016; 159:327-33. [PMID: 27510185 PMCID: PMC5509538 DOI: 10.1007/s10549-016-3939-0] [Citation(s) in RCA: 216] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/06/2016] [Indexed: 12/25/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity associated with chemotherapy, but researchers rarely study its risk factors, fall risk, and prevalence in long-term breast cancer survivors. We aimed to determine CIPN prevalence, risk factors, and association with psychological distress and falls among long-term breast cancer survivors. We conducted Cross-sectional analyses among postmenopausal women with a history of stage I-III breast cancer who received taxane-based chemotherapy. Participants reported neuropathic symptoms of tingling/numbness in hands and/or feet on a 0-10 numerical rating scale. We conducted multivariate logistic regression analyses to evaluate risk factors associated with the presence of CIPN and the relationship between CIPN and anxiety, depression, insomnia, and patient-reported falls. Among 296 participants, 173 (58.4 %) reported CIPN symptoms, 91 (30.7 %) rated their symptoms as mild, and 82 (27.7 %) rated them moderate to severe. Compared with women of normal weight, being obese was associated with increased risk of CIPN (adjusted OR 1.94, 95 % CI: 1.03-3.65). Patients with CIPN reported greater insomnia severity, anxiety, and depression than those without (all p < 0.05). Severity of CIPN was associated with higher rates of falls, with 23.8, 31.9, and 41.5 % in the "no CIPN," "mild," and "moderate-to-severe" groups, respectively, experiencing falls (p = 0.028). The majority of long-term breast cancer survivors who received taxane-based chemotherapy reported CIPN symptoms; obesity was a significant risk factor. Those with CIPN also reported increased psychological distress and falls. Interventions need to target CIPN and comorbid psychological symptoms, and incorporate fall prevention strategies for aging breast cancer survivors.
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Affiliation(s)
- Ting Bao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA.
| | - Coby Basal
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Christina Seluzicki
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Susan Q Li
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
| | - Andrew D Seidman
- Memorial Sloan Kettering Cancer Center, 300 66th Street, New York, NY, 10065, USA
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY, 10021, USA
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158
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Arthur JA, Edwards T, Lu Z, Reddy S, Hui D, Wu J, Liu D, Williams JL, Bruera E. Frequency, predictors, and outcomes of urine drug testing among patients with advanced cancer on chronic opioid therapy at an outpatient supportive care clinic. Cancer 2016; 122:3732-3739. [PMID: 27509305 DOI: 10.1002/cncr.30240] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/01/2016] [Accepted: 07/01/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Data are limited on the use and outcomes of urine drug tests (UDTs) among patients with advanced cancer. The main objective of this study was to determine the factors associated with UDT ordering and results in outpatients with advanced cancer. METHODS A retrospective chart review was conducted of 1058 patients who attended an outpatient supportive care clinic from March 2014 to November 2015. Sixty-one patients who were receiving chronic opioid therapy and underwent UDTs were identified. A control group of 120 patients who did not undergo UDTs was selected for comparison. RESULTS Sixty-one of 1058 patients (6%) underwent UDTs, and 33 of 61 patients (54%) had abnormal results. Multivariate analysis indicated that the odds ratio for UDT ordering was 3.9 in patients who had positive Cut Down, Annoyed, Guilty, and Eye Opener (CAGE) questionnaire results (P = .002), 4.41 in patients aged < 45 years (P < .001), 5.58 in patients who had moderate-to-severe pain (Edmonton Symptom Assessment Scale pain scores ≥4; P < .001), 0.27 in patients with advanced-stage cancer, (P = .008), and 0.25 in patients who had moderate-to-severe fatigue (P = .001). Among 52 abnormal UDT results in 33 patients, the most common opioid findings were prescribed opioids absent in urine (14 of 52 tests; 27%) and unprescribed opioids in urine (13 of 52 tests; 25%). CONCLUSIONS UDTs were used infrequently among outpatients with advanced cancer who were receiving chronic opioid therapy. Younger age, positive CAGE questionnaire results, early stage cancer or no evidence of disease status, higher pain intensity, and lower fatigue scores were significant predictors of UDT ordering. More than 50% of UDT results were abnormal. More research is necessary to better characterize aberrant opioid use in patients with advanced cancer. Cancer 2016;122:3732-9. © 2016 American Cancer Society.
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Affiliation(s)
- Joseph A Arthur
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Tonya Edwards
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Zhanni Lu
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Suresh Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Jimin Wu
- Department of Quantitative Sciences, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Janet L Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, Texas
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159
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Oldenmenger WH, Witkamp FE, Bromberg JEC, Jongen JLM, Lieverse PJ, Huygen FJPM, Baan MAG, van Zuylen L, van der Rijt CCD. To be in pain (or not): a computer enables outpatients to inform their physician. Ann Oncol 2016; 27:1776-81. [PMID: 27443633 DOI: 10.1093/annonc/mdw250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the outpatient oncology clinic, pain management is often inadequate. Incorporating a systematic pain management program into visits is likely to improve this. We implemented an integrated program, including a structured pain assessment, pain treatment protocol and patient education module. In the present study, we investigated whether this intervention improved pain control. PATIENTS AND METHODS At seven oncology outpatient clinics, patients were asked to register their pain intensity on a touch screen computer. These scores were made available into their electronic medical records. Additionally, a hospital-wide treatment protocol for cancer-related pain and a patient education module were developed. A data warehouse system enabled us to extract patient data from the electronic medical record anonymously and to use them for analysis. The primary outcome of the study was the percentage of patients with moderate to severe pain [current pain (CPI), NRS > 4] measured during 2 weeks at the start and 6 months after implementation. As secondary outcomes, we studied the percentage of pain registrations in specific patient groups and the percentage of patients treated with a curative and a palliative intention with (moderate-severe) pain. Differences were tested with the χ(2) test. RESULTS During the first 6 months, 3407 of the 4345 patients (78%) registered their pain intensity on the touch screen computer. The percentage of patients with moderate to severe CPI decreased 32% (P = 0.021): from 12.5% at start to 8.5% after 6 months. More patients in the palliative phase than in the curative phase of their disease registered their pain intensity (82% versus 75%, respectively, P < 0.005), and more patients in the palliative phase experienced moderate to severe pain (23% versus 14%, respectively, P < 0.001). CONCLUSION Pain registration by patients themselves is feasible, provides insight into patients' pain intensity and may improve pain control in outpatients with cancer-related pain. CLINICAL TRIAL NUMBER Because this is an innovation project and not a primary research project, it has no clinical trial number. The protocol and all materials involved were approved by the Institutional Review Board of the Erasmus MC (MEC-2009-324).
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Affiliation(s)
- W H Oldenmenger
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam
| | - F E Witkamp
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam
| | | | | | - P J Lieverse
- Department of Anesthesiology, Erasmus MC, Rotterdam
| | | | - M A G Baan
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam
| | - L van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam Department of Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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de Graaf E, Zweers D, Valkenburg AC, Uyttewaal A, Teunissen SC. Hospice assist at home: does the integration of hospice care in primary healthcare support patients to die in their preferred location - A retrospective cross-sectional evaluation study. Palliat Med 2016; 30:580-6. [PMID: 26814216 DOI: 10.1177/0269216315626353] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A majority of patients prefer to die at home. Specialist palliative care aims to improve quality of life. Hospice assist at home is a Dutch model of general/specialised palliative care within primary care, collaboratively built by general practitioners and a hospice. AIM The aims of this study are to explore whether hospice assist at home service enables patients at hometo express end-of-life preferences and die in their preferred location. In addition, this study provides insight into symptomburden, stability and early referral. DESIGN A retrospective cross-sectional evaluation study was performed (December 2014-March 2015), using hospice assist at home patient records and documentation. Primary outcome includes congruence between preferred and actual place of death. Secondary outcomes include symptom burden, (in)stability and early identification. SETTING/PARTICIPANTS Between June 2012 and December 2014, 130 hospice assist at home patients, living at home with a life expectancy <1 year, were enrolled. Hospice assist at home, a collaboration between general practitioners, district nurses, trained volunteers and a hospice team, facilitates (1) general practitioner-initiated consultation by Nurse Consultant Hospice, (2) fortnightly interdisciplinary consultations and (3) 24/7 hospice backup for patients, caregivers and professionals. RESULTS A total of 130 patients (62 (48%) men; mean age, 72 years) were enrolled, of whom 107/130 (82%) died and 5 dropped out. Preferred place of death was known for 101/107 (94%) patients of whom 91% patients died at their preferred place of death. CONCLUSION Hospice assist at home service supports patients to die in their preferred place of death. Shared responsibility of proactive care in primary care collaboration enabled patients to express preferences. Hospice care should focus on local teamwork, to contribute to shared responsibilities in providing optimal palliative care.
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Affiliation(s)
- Everlien de Graaf
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands
| | - Daniëlle Zweers
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anna Ch Valkenburg
- Academic Hospice Demeter, De Bilt, The Netherlands Community Health Center, De Bilt, The Netherlands
| | | | - Saskia Ccm Teunissen
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands Academic Hospice Demeter, De Bilt, The Netherlands
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Løhre ET, Klepstad P, Bennett MI, Brunelli C, Caraceni A, Fainsinger RL, Knudsen AK, Mercadante S, Sjøgren P, Kaasa S. From "Breakthrough" to "Episodic" Cancer Pain? A European Association for Palliative Care Research Network Expert Delphi Survey Toward a Common Terminology and Classification of Transient Cancer Pain Exacerbations. J Pain Symptom Manage 2016; 51:1013-9. [PMID: 26921493 DOI: 10.1016/j.jpainsymman.2015.12.329] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/05/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Cancer pain can appear with spikes of higher intensity. Breakthrough cancer pain (BTCP) is the most common term for the transient exacerbations of pain, but the ability of the nomenclature to capture relevant pain variations and give treatment guidance is questionable. OBJECTIVES To reach consensus on definitions, terminology, and subclassification of transient cancer pain exacerbations. METHODS The most frequent authors on BTCP literature were identified using the same search strategy as in a systematic review and invited to participate in a two-round Delphi survey. Topics with a low degree of consensus on BTCP classification were refined into 20 statements. The participants rated their degree of agreement with the statements on a numeric rating scale (0-10). Consensus was defined as a median numeric rating scale score of ≥7 and an interquartile range of ≤3. RESULTS Fifty-two authors had published three or more articles on BTCP over the past 10 years. Twenty-seven responded in the first round and 24 in the second round. Consensus was reached for 13 of 20 statements. Transient cancer pain exacerbations can occur without background pain, when background pain is uncontrolled, and regardless of opioid treatment. There exist cancer pain exacerbations other than BTCP, and the phenomenon could be named "episodic pain." Patient-reported treatment satisfaction is important with respect to assessment. Subclassification according to pain pathophysiology can provide treatment guidance. CONCLUSION Significant transient cancer pain exacerbations include more than just BTCP. Patient input and pain classification are important factors for tailoring treatment.
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Affiliation(s)
- Erik Torbjørn Løhre
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Cinzia Brunelli
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Augusto Caraceni
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Robin L Fainsinger
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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162
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Kjaer T, Dalton SO, Andersen E, Karlsen R, Nielsen AL, Hansen MK, Frederiksen K, Johansen C. A controlled study of use of patient-reported outcomes to improve assessment of late effects after treatment for head-and-neck cancer. Radiother Oncol 2016; 119:221-8. [PMID: 27178143 DOI: 10.1016/j.radonc.2016.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE To test the effect of longitudinal feedback on late effects reported by survivors of head-and-neck cancer (HNC) to clinicians during regular follow-up. MATERIAL AND METHODS A total of 266 participants were sequentially assigned to either control or intervention group and filled in electronic versions of the EORTC QLQ C-30, H&N35, HADS and a study-specific list of symptoms at up to two consecutive follow-up visits. Participants' symptoms displayed according to severity were provided to the clinician for the intervention group but not for the control group. Linear mixed-effects models were used to examine the number of symptoms assessed by clinicians (primary outcome). Multivariate linear regression models examined participants' long-term symptom control and QoL (secondary outcome). RESULTS More symptoms were assessed by clinicians in the intervention group at all three visits (P<0.001, <0.001, and P=0.04). No effect was observed on most patient outcomes. When prompted by patient-reported outcomes at consultations, clinicians and patients were in better agreement about the occurrence of severe symptoms at all three visits. CONCLUSION Timely patient-reported outcomes to clinicians in routine follow-up of HNC survivors enhanced clinicians' rates of assessment of late symptoms. Giving reports of patient-reported outcome to clinicians had limited impact on participants' QoL or symptom burden.
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Affiliation(s)
- Trille Kjaer
- Danish Cancer Society Research Center, Copenhagen, Denmark.
| | | | - Elo Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark
| | - Randi Karlsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Merete Kjaer Hansen
- Department of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Department of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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163
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Sharabi IS, Levin A, Schiff E, Samuels N, Agour O, Tapiro Y, Lev E, Keinan-Boker L, Ben-Arye E. Quality of life-related outcomes from a patient-tailored integrative medicine program: experience of Russian-speaking patients with cancer in Israel. Support Care Cancer 2016; 24:4345-55. [PMID: 27169571 DOI: 10.1007/s00520-016-3274-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/05/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Complementary/integrative medicine (CIM) is increasingly being integrated with standard supportive cancer care. The effects of CIM on quality of life (QOL) during chemotherapy need to be examined in varied socio-cultural settings. We purpose to explore the impact of CIM on QOL-related outcomes among Russian-speaking (RS) patients with cancer. PATIENTS AND METHODS RS patients undergoing chemotherapy receiving standard supportive care were eligible. Patients in the treatment arm were seen by an integrative physician (IP) and treated within a patient-tailored CIM program. Symptoms and QOL were assessed at baseline, at 6, and at 12 weeks with the Edmonton Symptom Assessment Scale (ESAS), the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). RESULTS Of 70 patients referred to the treatment arm, 50 (71.4 %) underwent IP assessment and CIM treatments. Of 51 referred to the control arm, 38 (76 %) agreed to participate. At 6 weeks, CIM-treated patients reported improved ESAS scores for fatigue (P = 0.01), depression (P = 0.048), appetite (P = 0.008), sleep (P < 0.0001), and general wellbeing (P = 0.004). No improvement was observed among controls. Between-group analysis found CIM-treated patients had improved sleep scores on ESAS (P = 0.019) and EORTC (P = 0.007) at 6 weeks. Social functioning improved between 6 and 12 weeks (EORTC, P = 0.02), and global health status/QOL scale from baseline to 12 weeks (EORTC, P = 0.007). CONCLUSION A patient-tailored CIM treatment program may improve QOL-related outcomes among RS patients undergoing chemotherapy. Integrating CIM in conventional supportive care needs to address cross-cultural aspects of care. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT01860365 ).
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Affiliation(s)
- Ilanit Shalom Sharabi
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Anna Levin
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Elad Schiff
- Department of Internal Medicine, and Integrative Medicine Service, Bnai-Zion Hospital, Haifa, Israel; The Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Tal Center for Integrative Medicine, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Olga Agour
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.,Social-Work Service, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Yehudith Tapiro
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel
| | - Efraim Lev
- Department of Eretz Israel Studies, University of Haifa, Haifa, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Jerusalem, Israel.,School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel. .,Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Clalit Health Services, Haifa and Western Galilee District, Israel. .,The Oncology Service, Lin Medical Center, 35 Rothschild St., Haifa, Israel.
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164
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Ekström M, Allingham SF, Eagar K, Yates P, Johnson C, Currow DC. Breathlessness During the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study. J Pain Symptom Manage 2016; 51:816-23. [PMID: 26802626 DOI: 10.1016/j.jpainsymman.2015.12.311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/20/2022]
Abstract
CONTEXT Breathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. OBJECTIVES To determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. METHODS This was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0-10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. RESULTS A total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8-3.4). CONCLUSION Although breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.
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Affiliation(s)
- Magnus Ekström
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Samuel F Allingham
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kathy Eagar
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Patsy Yates
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire Johnson
- The Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - David C Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
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165
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Haugdahl HS, Storli SL, Meland B, Dybwik K, Romild U, Klepstad P. Underestimation of Patient Breathlessness by Nurses and Physicians during a Spontaneous Breathing Trial. Am J Respir Crit Care Med 2016; 192:1440-8. [PMID: 26669474 DOI: 10.1164/rccm.201503-0419oc] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Breathlessness is a prevalent and distressing symptom in intensive care unit patients. There is little evidence of the ability of healthcare workers to assess the patient's experiences of breathing. Patient perception of breathing is essential in symptom management, and patient perception during a spontaneous breathing trial (SBT) might be related to extubation success. OBJECTIVES To assess mechanically ventilated patients' experiences of breathlessness during SBT. METHODS This was a prospective observational multicenter study of 100 mechanically ventilated patients. We assessed the agreement between nurses, physicians, and patients' 11-point Numerical Rating Scales scores of breathlessness, perception of feeling secure, and improvement of respiratory function at the end of an SBT (most performed with some level of support). We also determined the association between breathlessness and demographic factors or respiratory observations. MEASUREMENTS AND MAIN RESULTS Sixty-two patients (62%) reported moderate or severe breathlessness (Numerical Rating Scales ≥ 4). The median intensity of breathlessness reported by patients was five compared with two by nurses and physicians (P < 0.001). Patients felt less secure and reported less improvement of respiratory function compared with nurses' and physicians' ratings. About half of the nurses and physicians underestimated breathlessness (difference score, ≤-2) compared with the patients' self-reports. Underestimation of breathlessness was not associated with professional competencies. There were no major differences in objective assessments of respiratory function in patients with moderate or severe breathlessness, and no apparent relationship between breathlessness during the SBT and extubation outcome. CONCLUSIONS Patients reported higher breathlessness after SBT compared with nurses and physicians. Clinical trial registered with www.clinicaltrials.gov (NCT 01928277).
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Affiliation(s)
- Hege S Haugdahl
- 1 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,2 Department for Research, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.,3 Nord Trøndelag University College, Levanger, Norway
| | - Sissel L Storli
- 1 Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Barbro Meland
- 4 Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Knut Dybwik
- 5 Department of Anesthesiology, Nordland Hospital, Bodø, Norway.,6 Faculty of Professional Studies, University of Nordland, Bodø, Norway
| | - Ulla Romild
- 2 Department for Research, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.,7 Public Health Agency of Sweden, Östersund, Sweden; and
| | - Pål Klepstad
- 4 Department of Intensive Care Medicine, St. Olav University Hospital, Trondheim, Norway.,8 Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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166
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Hui D, Park M, Shamieh O, Paiva CE, Perez-Cruz PE, Muckaden MA, Bruera E. Personalized symptom goals and response in patients with advanced cancer. Cancer 2016; 122:1774-81. [PMID: 26970366 DOI: 10.1002/cncr.29970] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/12/2016] [Accepted: 02/05/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Improving symptoms is a major goal of cancer medicine; however, symptom response is often based on group differences and not individualized. In the current study, the authors examined the personalized symptom goal (PSG) for 10 common symptoms in patients with advanced cancer, and identified the factors associated with PSG response. METHODS In this prospective, longitudinal, multicenter study, patients from 5 tertiary care hospitals rated the intensity of 10 symptoms using a numeric rating scale of 0 to 10 at the time of their first clinic visit and then at a second visit 14 to 34 days later. The PSG was determined for each symptom by asking patients: "At what level would you feel comfortable with this symptom?" using the same scale of 0 to 10 for symptom intensity. PSG response was defined as symptom intensity at the time of the second visit that was less than or equal to the PSG. RESULTS Among 728 patients, the median PSG was 1 for nausea; 2 for depression, anxiety, drowsiness, well-being, dyspnea, and sleep; and 3 for pain, fatigue, and appetite. A greater percentage of patients achieved a PSG response at their second visit compared with their first visit (P<.05 except for drowsiness). Symptom response was associated with lower baseline symptom intensity based on PSG criterion but higher baseline symptom intensity based on the traditional minimal clinically important difference definition (P<.001 for all symptoms). In multivariable analysis, higher PSG and nationality were associated with greater PSG response. CONCLUSIONS The PSG was ≤3 for a majority of patients. PSG response allows clinicians to tailor treatment goals while adjusting for individual differences in scale interpretation and factors associated with symptom response. Cancer 2016;122:1774-81. © 2016 American Cancer Society.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Omar Shamieh
- Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | | | - Pedro Emilio Perez-Cruz
- Department of Internal Medicine, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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167
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The Dutch patients' perspective on oculopharyngeal muscular dystrophy: A questionnaire study on fatigue, pain and impairments. Neuromuscul Disord 2016; 26:221-6. [PMID: 26948710 DOI: 10.1016/j.nmd.2015.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 01/05/2023]
Abstract
Research on oculopharyngeal muscular dystrophy focuses mainly on genetic and pathophysiological aspects. Clinically, oculopharyngeal muscular dystrophy is often considered as a disease with a relatively mild initial disease course with no or only mild functional disabilities. However the occurrence of fatigue, pain and functional impairments other than dysphagia has never been studied systematically. The aim of this study is therefore to assess the prevalence of fatigue, pain, and functional limitations, and the social participation and psychological well-being of oculopharyngeal muscular dystrophy patients. We performed a questionnaire study on fatigue, pain, functional impairments, social participation and psychological distress in 35 genetically confirmed oculopharyngeal muscular dystrophy patients with an average disease duration of 11.6 years. We showed that 19 (54%) of the patients experienced severe fatigue and also 19 (54%) experienced pain. Limitations in daily life activities and social participation were detected in 33 (94%) of the patients. Many patients reported pelvic girdle weakness and limitations in ambulation. Fatigue severity was related to functional impairments, while pain and disease duration were not. Psychological distress was not different from healthy adults. In conclusion, fatigue and pain are present among approximately half of the patients, and almost all patients are impaired in daily life activities, social participation and ambulation. These data should be taken into account in symptomatic management of oculopharyngeal muscular dystrophy.
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168
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LeBaron VT, Blonquist TM, Hong F, Halpenny B, Berry DL. Screening for Pain in the Ambulatory Cancer Setting: Is 0-10 Enough? J Oncol Pract 2015; 11:435-41. [PMID: 26306620 PMCID: PMC4647066 DOI: 10.1200/jop.2015.004077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to explore concordance between patient self-reports of pain on validated questionnaires and discussions of pain in the ambulatory oncology setting. METHODS Adult, ambulatory patients (N = 452) with all stages of cancer were included. Three pain measures were evaluated: two items from the Symptom Distress Scale (frequency [SDSF] and intensity [SDSI]) and the Pain Intensity Numeric Scale (PINS). Relevant pain was defined as: (1) scores 3 of 5 on SDSF or SDSI or 5 of 10 on the (PINS); or (2) discussion of existing pain in an audio-recorded clinic visit. For each scale, McNemar's test assessed concordance of patient self-reports of relevant pain with discussions of relevant pain in the audio-recorded clinic visit. Sensitivity, specificity, and accuracy were calculated and a receiver operating characteristic analysis evaluated thresholds on self-report pain questionnaires to best identify relevant pain discussed in clinic. RESULTS Identification of relevant pain by self-report was discordant (P < .001) with discussed pain coded in audio-recorded visits for all three measures. Specificity was higher for intensity (SDSI, 0.94; PINS, 0.97) than frequency (SDSF, 0.87); sensitivity was higher for frequency (SDSF, 0.35) than intensity (SDSI, 0.24; PINS, 0.12). Accuracy was higher for the SDS pain items (SDSF, 0.57; SDSI, 0.54) than for PINS (0.48). Receiver operating characteristic analysis curves suggest that lower threshold scores may improve the identification of relevant pain. CONCLUSION Self-report pain screening measures favored specificity over sensitivity. Asking about pain frequency (in addition to intensity) and reconsidering threshold scores on pain intensity scales may be practical strategies to more accurately identify patients with cancer who have relevant pain.
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Affiliation(s)
- Virginia T LeBaron
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Traci M Blonquist
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Fangxin Hong
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Barbara Halpenny
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
| | - Donna L Berry
- University of Virginia School of Nursing, Charlottesville, VA; Dana-Farber Cancer Institute; Phyllis F. Cantor Center for Research in Nursing and Patient Care Services; and Harvard Medical School, Boston, MA
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169
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Zhang LB, Wang B, Wang XY, Zhang L. Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients. Med Oncol 2015; 32:201. [DOI: 10.1007/s12032-015-0639-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/19/2015] [Indexed: 11/27/2022]
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170
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Oligoanalgesia in Blunt Geriatric Trauma. J Emerg Med 2015; 48:653-9. [DOI: 10.1016/j.jemermed.2014.12.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/17/2014] [Accepted: 12/21/2014] [Indexed: 11/16/2022]
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171
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Berger AM, Mitchell SA, Jacobsen PB, Pirl WF. Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice? CA Cancer J Clin 2015; 65:190-211. [PMID: 25760293 DOI: 10.3322/caac.21268] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 12/13/2022] Open
Abstract
Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.
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Affiliation(s)
- Ann M Berger
- University of Nebraska Medical Center College of Nursing, Fred and Pamela Buffett Cancer Center, Omaha, NE
| | - Sandra A Mitchell
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - William F Pirl
- Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Lefkowits C, Teuteberg W, Courtney-Brooks M, Sukumvanich P, Ruskin R, Kelley JL. Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients. Gynecol Oncol 2015; 136:424-8. [DOI: 10.1016/j.ygyno.2014.12.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/04/2014] [Accepted: 12/15/2014] [Indexed: 12/25/2022]
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173
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Payne KS, Schilli K, Meier K, Rader RK, Dyer JA, Mold JW, Green JA, Stoecker WV. Extreme pain from brown recluse spider bites: model for cytokine-driven pain. JAMA Dermatol 2015; 150:1205-8. [PMID: 25076008 DOI: 10.1001/jamadermatol.2014.605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Bites from the brown recluse spider (BRS) can cause extreme pain. We propose cytokine release as a cause of the discomfort and a central mechanism through glial cell upregulation to explain measured pain levels and time course. OBSERVATIONS Twenty-three BRS bites were scored at a probable or documented level clinically, and an enzyme-linked immunosorbent assay was used to confirm the presence of BRS venom. The mean (SD) pain level in these cases 24 hours after the spider bite was severe: 6.74 (2.75) on a scale of 0 to 10. Narcotics may be needed to provide relief in some cases. The difference in pain level by anatomic region was not significant. Escalation observed in 22 of 23 cases, increasing from low/none to extreme within 24 hours, is consistent with a cytokine pain pattern, in which pain increases concomitantly with a temporal increase of inflammatory cytokines. CONCLUSIONS AND RELEVANCE These findings in BRS bites support the hypothesis of cytokine release in inflammatory pain. A larger series is needed to confirm the findings reported here. The extreme pain from many BRS bites motivates us to find better prevention and treatment techniques.
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Affiliation(s)
| | | | | | - Ryan K Rader
- Stoecker & Associates, Rolla, Missouri2University of Missouri School of Medicine, Columbia
| | - Jonathan A Dyer
- Department of Dermatology, University of Missouri School of Medicine, Columbia
| | - James W Mold
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
| | | | - William V Stoecker
- Stoecker & Associates, Rolla, Missouri3Department of Dermatology, University of Missouri School of Medicine, Columbia
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Abstract
PURPOSE OF REVIEW Adequate cancer pain assessment using valid and reliable tools is essential for proper cancer pain management. Because cancer pain can be a complex construct, assessment of its many domains should be conducted using multidimensional tools. Furthermore, there is a need to develop a standard, consensus classification system for prognosis of cancer pain. RECENT FINDINGS Unidimensional tools for assessing cancer pain are useful for measuring cancer pain intensity. Other domains and symptoms of the cancer pain experience are assessed using a variety of multidimensional tools. There is a lack of agreement on a standard assessment tool or a standard classification system for cancer pain, although research continues to be undertaken to develop such resources for clinical and research purposes. SUMMARY Many pain and symptom assessment tools exist for use in the cancer patient, including the Brief Pain Inventory, the McGill Pain Questionnaire, the MD Anderson Symptom Inventory, and the Edmonton Symptom Assessment System, among others. Recent literature reveals the move toward translating these and other tools to electronic applications. Further study is also underway to create a standard, prognostic classification system for cancer pain.
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175
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Keshet Y, Schiff E, Samuels N, Ben-Arye E. Giving voice to cancer patients: assessing non-specific effects of an integrative oncology therapeutic program via short patient narratives. Psychooncology 2014; 24:169-74. [PMID: 25043932 DOI: 10.1002/pon.3621] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/18/2014] [Accepted: 06/19/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess patient perspectives regarding non-specific effects of a complementary medicine (CM) consultation and intervention within an integrative oncology setting. METHODS Patients undergoing chemotherapy in a community-based oncology service were referred by oncology healthcare providers to an integrative oncology physician trained in CM-oriented supportive care. Assessment of concerns and well-being was made using the Measure Yourself Concerns and Wellbeing questionnaire, at baseline and after 3 months of CM treatments, which were designed to improve quality of life (QoL) outcomes. Patients were asked to describe the most important aspects of the integrative treatment process. Free-text narratives were examined using content analysis with ATLAS.Ti software for systematic coding. RESULTS Of 152 patients' narratives analyzed, 44% reported an experience of patient-centered care, including CM practitioners' approach of togetherness, uniqueness, and the invoking of an internal process. CM practitioner approach was experienced within a context of an enhanced sense of confidence; gaining a different perspective; and acquiring emotional resilience and empowerment. CONCLUSIONS Short patient narratives should be considered for patient-reported outcomes, expressing perspectives of both effects and experience of care. CM may promote patient QoL-related outcomes through non-specific effects, enhancing patient-centered care. The benefits of CM dependent on general therapeutic incidental aspects (i.e., common factors) warrant attention regarding non-specific components of treatment.
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Affiliation(s)
- Yael Keshet
- Department of Sociology and Anthropology, Western Galilee Academic College, Galilee, Israel
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176
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Ben-Arye E, Kruger D, Samuels N, Keinan-Boker L, Shalom T, Schiff E. Assessing patient adherence to a complementary medicine treatment regimen in an integrative supportive care setting. Support Care Cancer 2014; 22:627-44. [PMID: 24122407 DOI: 10.1007/s00520-013-2016-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Patients with cancer are frequently turning to complementary medicine (CM), often with the goal of improving quality of life outcomes. The purpose of the present study was to assess the adherence of patients referred by oncology practitioners to a CM consultation and treatment program. PATIENTS AND METHODS A prospective registry protocol-based, preference study was conducted at a conventional oncology department. Patients undergoing chemotherapy were referred by participating oncology practitioners to a CM-trained integrative physician (IP) for consultation. Adherence to the integrative care (AIC) program was defined as attendance by patients at ≥4 CM treatment sessions, with an interval of no more than 30 days between each session. RESULTS A total of 282 patients were referred by the study health-care professionals (HCPs), of whom 243 (85.8%) were eventually seen by the study IP. Of these, 160 were found to be adherent to the treatment plan (AIC group), and 83 were nonadherent (non-AIC group). No significant differences were found between the two groups with respect to demographic characteristics, medical history, site of malignancy and/or recurrence, chemotherapy regimen, or severity of symptoms at baseline. The AIC group reported significantly greater rates of CM use for noncancer-related indications than the non-AIC group (EXP(B)=2.174, 95% confidence interval (C.I.)=1.1–4.295, p =0.025). Patients in the non-AIC group were referred more frequently by their HCP for gastrointestinal concerns than those in the AIC group (p =0.022). CONCLUSIONS Previous use of CM for noncancer-related outcomes was found to be predictive of patient adherence to a CM treatment regimen provided within conventional oncology service.
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177
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Buehrer S, Hanke U, Klaghofer R, Fruehauf M, Weiss M, Schmitz A. Hunger and thirst numeric rating scales are not valid estimates for gastric content volumes: a prospective investigation in healthy children. Paediatr Anaesth 2014; 24:309-15. [PMID: 24467570 DOI: 10.1111/pan.12276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 12/01/2022]
Abstract
AIM A rating scale for thirst and hunger was evaluated as a noninvasive, simple and commonly available tool to estimate preanesthetic gastric volume, a surrogate parameter for the risk of perioperative pulmonary aspiration, in healthy volunteer school age children. METHOD Numeric scales with scores from 0 to 10 combined with smileys to rate thirst and hunger were analyzed and compared with residual gastric volumes as measured by magnetic resonance imaging and fasting times in three settings: before and for 2 h after drinking clear fluid (group A, 7 ml/kg), before and for 4 vs 6 h after a light breakfast followed by clear fluid (7 ml/kg) after 2 vs 4 h (crossover, group B), and before and for 1 h after drinking clear fluid (crossover, group C, 7 vs 3 ml/kg). RESULTS In 30 children aged 6.4-12.8 (median 9.8) years, participating on 1-5 (median two) study days, 496 sets of scores and gastric volumes were determined. Large inter- and intra-individual variations were seen at baseline and in response to fluid and food intake. Significant correlations were found between hunger and thirst ratings in all groups, with children generally being more hungry than thirsty. Correlations between scores and duration of fasting or gastric residual volumes were poor to moderate. Receiver operating characteristic (ROC) analysis revealed that thirst and hunger rating scales cannot predict gastric content. CONCLUSION Hunger and thirst scores vary considerably inter- and intra-individually and cannot predict gastric volume, nor do they correlate with fasting times in school age children.
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Affiliation(s)
- Sabin Buehrer
- Department of Anesthesia, University Children's Hospital, Zurich, Switzerland
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178
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Wang XS, Zhao F, Fisch MJ, O’Mara AM, Cella D, Mendoza TR, Cleeland CS. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer 2014; 120:425-32. [PMID: 24436136 PMCID: PMC3949157 DOI: 10.1002/cncr.28434] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/30/2013] [Accepted: 09/16/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND The effective management of fatigue in patients with cancer requires a clear delineation of what constitutes nontrivial fatigue. The authors defined numeric cutpoints for fatigue severity based on functional interference and described the prevalence and characteristics of fatigue in patients with cancer and survivors. METHODS In a multicenter study, outpatients with breast, prostate, colorectal, or lung cancer rated their fatigue severity and symptom interference with functioning on the M. D. Anderson Symptom Inventory numeric scale of 0 to 10. Ratings of symptom interference guided the selection of numeric rating cutpoints between mild, moderate, and severe fatigue levels. Regression analysis identified significant factors related to reporting moderate=severe fatigue . RESULTS The statistically optimal cutpoints were 4 for moderate fatigue and 7 for severe fatigue. Moderate=severe fatigue was reported by 983 of 2177 patients (45%) undergoing active treatment and was more likely to occur in patients receiving treatment with strong opioids (odds ratio [OR], 3.00), those with a poor Eastern Cooperative Oncology Group performance status (OR, 2.00), those who had >5% weight loss within 6 months (OR, 1.60), those who were receiving >10 medications (OR, 1.58), those with lung cancer (OR, 1.55), and those with a history of depression (OR, 1.42). Among survivors (patients with complete remission or no evidence of disease, and not currently receiving cancer treatment), 29% of patients (150 of 515 patients) had moderate=severe fatigue that was associated with poor performance status (OR, 3.48) and a history of depression (OR, 2.21). CONCLUSIONS The current study statistically defined fatigue severity categories related to significantly increased symptom interference. The high prevalence of moderate=severe fatigue in both actively treated patients with cancer and survivors warrants the promoting of the routine assessment and management of patient-reported fatigue.
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Affiliation(s)
- Xin Shelley Wang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michael J. Fisch
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Tito R. Mendoza
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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179
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Deandrea S, Corli O, Consonni D, Villani W, Greco MT, Apolone G. Prevalence of breakthrough cancer pain: a systematic review and a pooled analysis of published literature. J Pain Symptom Manage 2014; 47:57-76. [PMID: 23796584 DOI: 10.1016/j.jpainsymman.2013.02.015] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/18/2013] [Accepted: 02/22/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Despite the large body of literature on breakthrough cancer pain (BTcP), an accurate estimate of BTcP prevalence is still not available. OBJECTIVES To provide an estimate of BTcP prevalence and investigate the association between different prevalence rates and possible determinants. METHODS We conducted MEDLINE and EMBASE searches for studies published from 1990 to 2012 reporting data on BTcP prevalence in adult cancer populations. Pooled prevalence rates from observational studies with an acceptable methodological quality were computed. The association between BTcP prevalence and possible predictors was investigated using subgroup analyses and meta-regression. RESULTS Twenty-seven observational studies were identified. When quality criteria were applied, only 19 studies were included in the pooled analysis. The overall pooled prevalence was 59.2%, with high heterogeneity. The lowest prevalence rates were detected in studies conducted in outpatient clinics (39.9%), and the highest prevalence was reported in studies conducted in hospice (80.5%). The association between BTcP prevalence and other determinants such as publication year, age, gender, metastatic disease prevalence, or baseline pain intensity did not reach statistical significance. CONCLUSION In the context of a large between-studies heterogeneity, more than one in two patients with cancer pain also experiences BTcP, with some variability according to clinical and organizational variables.
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Affiliation(s)
- Silvia Deandrea
- Center for the Evaluation and Research on Pain (CERP), IRCCS Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy; Istituto di Statistica Medica e Biometria "G. A. Maccacaro,", Università degli Studi di Milano, Milan, Italy.
| | - Oscar Corli
- Center for the Evaluation and Research on Pain (CERP), IRCCS Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | - Dario Consonni
- Unit of Epidemiology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Walter Villani
- Center for the Evaluation and Research on Pain (CERP), IRCCS Istituto di Ricerche Farmacologiche "Mario Negri," Milan, Italy
| | - Maria Teresa Greco
- Istituto di Statistica Medica e Biometria "G. A. Maccacaro,", Università degli Studi di Milano, Milan, Italy
| | - Giovanni Apolone
- Direzione Scientifica, IRCCS Arcispedale Santa Maria Nuova, Reggio-Emilia, Italy
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180
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Ben-Arye E, Schiff E, Raz OG, Samuels N, Lavie O. Integrating a complementary medicine consultation for women undergoing chemotherapy. Int J Gynaecol Obstet 2013; 124:51-4. [PMID: 24140221 DOI: 10.1016/j.ijgo.2013.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/06/2013] [Accepted: 09/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore oncology healthcare providers' (HCPs') patterns of referral of women undergoing chemotherapy to a complementary medicine (CM) consultation integrated within a conventional oncology service. METHODS Oncology HCPs used a structured referral system for referral to an integrative physician (IP) for CM consultation. Referral goals were in accordance with a specified list of quality-of-life (QOL) outcomes. RESULTS In total, the study HCPs referred 282 female patients, of whom 238 (84.4%) underwent CM consultation by the study IP: 59 (24.8%) with gynecologic cancer and 179 (75.2%) with non-gynecologic cancer. Use of CM for cancer-related outcomes was significantly higher among referred patients with gynecologic cancer than those with non-gynecologic cancer (69.5% vs 46.9%; P=0.003). Oncologists initiated most of the referrals in the gynecologic oncology group, whereas oncologic nurses referred most patients in the non-gynecologic oncology group. Among patients with gynecologic cancer, the correlation between HCP indication and patient expectation was high for gastrointestinal concerns (κ 0.41). CONCLUSION The integration of a structured and informed process of referral to CM consultation may enhance patient-centered care and QOL during chemotherapy.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel; Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Elad Schiff
- Department of Internal Medicine and Integrative Surgery Service, Bnai Zion Hospital, Haifa, Israel
| | - Orit G Raz
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel; Clalit Complementary Medicine, Clalit Health Services, Haifa, Israel
| | - Noah Samuels
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel
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181
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Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit. Scand J Pain 2013; 4:190-197. [PMID: 29913651 DOI: 10.1016/j.sjpain.2013.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
Background In recent years, multidisciplinary rehabilitation (MDR) became an alternative treatment option for chronic non-cancer pain. MDR is mostly available in specialized pain units, usually at rehabilitation centers where the level of knowledge and therapeutically options to treat pain conditions are considered to be high. There is strong evidence that MDR in specialized pain units is affecting pain and improves the quality of life in a sustainable manner. There are few studies about MDR outcome in primary health care, especially in those units situated in rural areas and with a different population than that encountered in specialized hospitals. That, in spite of the fact that the prevalence of pain in the patients treated in primary care practice is about 30%. The aim of this study is to analyze the effectiveness of MDR for chronic non-cancer patients in a primary health care unit. Methods This study included a total of 51 patients with chronic pain conditions who were admitted and completed the local MDR-program at the primary health care unit in Arvika, Sweden. The major complaint categories were fibromyalgia (53%), pain from neck and shoulder (28%) or low back pain (12%). The inclusion criteria were age between 16 and 67 years and chronic non-cancer pain with at least 3 months duration. The multidisciplinary team consisted of a general practitioner, two physiotherapists, two psychologists and one occupational therapist. The 6-week treatment took place in group sessions with 6-8 members each and included cognitive-behavioral treatment, education on pain physiology, ergonomics, physical exercises and relaxation techniques. Primary outcomes included pain intensity, pain severity, anxiety and depression scores, social and physical activity, and secondary outcomes were sick leave, opioid consumption and health care utilization assessed in the beginning of the treatment and at one year follow-up. Data was taken from the Swedish Quality Register for Pain Rehabilitation (SQRP) and the patients' medical journal. Results One year after MDR treatment, sick leave decreased from 75.6% to 61.5% (p <0.05). Utilization of health-care during one year decreased significantly from 27.4 to 20.1 contacts (p = 0.02). There were significant improvements concerning social activity (p = 0.03) and depression (p <0.05), but not in anxiety (p = 0.1) and physical activity (p = 0.08). Although not statistically significant, some numerical decrease in the mean levels of pain intensity, pain severity and opioid consumption were reported one year after MDR (p > 0.05). Conclusions The results obtained one year after rehabilitation indicated that patients with chronic noncancer pain might benefit from MDR in primary health care settings. Implications This study suggests that MDR in primary care settings as well as MDR at specialized pain units may lead to better coping in chronic non-cancer pain conditions with lower depression scores and higher social activity, leading to lower sick leave. This study demonstrated that there is a place for MDR in primary health care units with the given advantage of local intervention in rural areas allowing the patients to achieve rehabilitation in their home environment.
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182
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Cut points for mild, moderate, and severe pain on the VAS for children and adolescents: what can be learned from 10 million ANOVAs? Pain 2013; 154:2626-2632. [PMID: 23742796 DOI: 10.1016/j.pain.2013.05.048] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 05/11/2013] [Accepted: 05/29/2013] [Indexed: 01/22/2023]
Abstract
Cut points that classify pain intensity into mild, moderate, and severe levels are widely used in pain research and clinical practice. At present, there are no agreed-upon cut points for the visual analog scale (VAS) in pediatric samples. We applied a method based on Serlin and colleagues' procedure (Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. PAIN(®) 1995;61:277-84) that was previously only used for the 0 to 10 numerical rating scale to empirically establish optimal cut points (OCs) for the VAS and used bootstrapping to estimate the variability of these thresholds. We analyzed data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study and defined OCs both for parental ratings of their children's pain and adolescents' self-ratings of pain intensity. Data from 2276 children (3 to 10 years; 54% female) and 2982 adolescents (11 to 17 years; 61% female) were analyzed. OCs were determined in a by-millimeter analysis that tested all possible 4851 OC combinations, and a truncated analysis were OCs were spaced 5 mm apart, resulting in 171 OC combinations. The OC method identified 2 different OCs for parental ratings and self-report, both in the by-millimeter and truncated analyses. When we estimated the variability of the by-millimeter analysis, we found that the specific OCs were only found in 11% of the samples. The truncated analysis revealed, however, that cut points of 35:60 are identified as optimal in both samples and are a viable alternative to separate cut points. We found a set of cut points that can be used both parental ratings of their children's pain and self-reports for adolescents. Adopting these cut points greatly enhances the comparability of trials. We call for more systematic assessment of diagnostic procedures in pain research.
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